Atypical herpes simplex encephalitis: Clinical, virologic, and neuropathologic evaluation (original) (raw)
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Case Report HERPES SIMPLEX ENCEPHALITIS AS A FATAL DISEASE :
disease with high mortality if misdiagnosed or untreated. It can presents with acute features such as a headache, fever, seizures and confusion. It sometimes suspected as meningitis before MRI, and then the patient loses a chance for survival because of late diagnosis, and late treatment as a result. The combination of clinical history and examination, brain computed tomography scan, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis have been used to establish the diagnosis. Here, we are presenting a rare case of HSE presenting as confusion, fever and disorientation with nonspecific CSF analysis, then seizures, and typical MRI findings consistent with HSE and CSF polymerase chain reaction positive for herpes simplex virus-1 DNA. Unfortunately the diagnosis was late, and even with acyclovir the patient died after 2 weeks. Herpes simplex encephalitis must be suspected in a patient with disoriented with coma or seizures, and MRI gives the best view for direction the management.
An unusual presentation of herpes simplex virus encephalitis
Case reports in medicine, 2012
We present a case of a 65-year-old man with an acute alteration in mental state that was initially diagnosed as a functional psychiatric condition. After extensive workup, herpes simplex virus type 1 (HSV-1) was detected in the patient's cerebrospinal fluid (CSF) by polymerase chain reaction (PCR), and he responded rapidly to treatment with acyclovir. The case illustrates the importance of actively excluding organic causes in such patients, the need to have a low threshold of suspicion for HSV encephalitis, and the central role of CSF PCR testing for the diagnosis of HSV encephalitis, even in the absence of CSF biochemical abnormalities.
Subacute presentation of herpes simplex virus-1 encephalitis: A rare case report
Journal of Medical Society, 2018
Herpes simplex virus 1 is a prevalent neurotropic pathogen that infects and establishes latency in peripheral sensory neurons. It can migrate into the central nervous system and cause encephalitis. e association between herpes simplex virus encephalitis and cerebral venous thrombosis is rare, with a very limited number of case reports described in the literature, despite the recognized thrombogenic effects of the virus. A 44-year-old man was brought to the emergency department with generalized tonic-clonic seizures requiring sedation and ventilation to control it. Initial brain computed tomography revealed cortical and subcortical edema on the left frontal lobe, and a subsequent contrast-enhanced exam showed absence of venous flow over the anterior half of the superior sagittal sinus. Cerebrospinal fluid polymerase chain reaction was positive for herpes simplex virus type 1, and the patient was started on acyclovir and anticoagulation, with clinical improvement. Acyclovir administration was maintained for 14 days and oral anticoagulation for one year, with no recurrence of thrombotic events or other complications. A well-timed treatment has a validated prognostic impact on herpes simplex encephalitis, making early recognition of its clinical aspects of main importance.
Herpes simplex virus encephalitis: A literature review
Romanian Journal of Neurology
HSVE (Herpes simplex virus encephalitis) is an infection caused by herpes simplex virus type 1 (HSV-1) or type 2 that produces neurologic problems. HSVE is associated with significant morbidity and mortality in adults even with antiviral medication, and it is a fatal disease in babies and children regardless of treatment. The most likely pathways include retrograde transmission through the olfactory or trigeminal nerves, as well as hematogenous spread. The most common presenting symptoms are encephalopathy, fever, convulsions, headache, and regional neurologic dysfunction. An accurate history and physical examination are required to identify Herpes simplex virus encephalitis (HSVE), and a prompt assessment is advised after the diagnosis has been established. HSVE is a neurodegenerative disease that may be fatal. Rapid diagnostic work-up and early diagnosis in all suspected or confirmed cases will result in early initiation of intravenous acyclovir, which may decrease morbidity and d...
Journal of Clinical Virology, 2014
Background: Herpes simplex virus (HSV) is one the most common causes of sporadic encephalitis worldwide. Objective: We aimed to determine clinical characteristics and prognosis of HSV encephalitis (HSVE) cases reviewed retrospectively from several collaborating centers. Study design: We searched hospital archives of the last 10 years for patients with HSVE diagnosis, i.e. clinical presentation compatible with encephalitis and brain involvement on magnetic resonance imaging (MRI) or detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction (PCR). Clinical characteristics were noted and patients were phone-interviewed. HSVE cases were grouped and analyzed as proven and probable, based on virological confirmation by PCR. Univariate and multivariate analyses were used to determine factors associated with prognosis. Results: A total of 106 patients (63 males; mean age, 44 years; range, 18-83 years) were included. Most common symptoms were changes in mental status, fever, headache, and seizure. HSV PCR was positive in 69% of patients tested, while brain involvement was detected on MRI in 95%. Acyclovir was started mostly within five days of main symptom and continued for ≥14 days. Case fatality rate was 8%, while 69% of patients recovered with sequelae. Favorable prognosis was observed in 73% of patients. Multivariate analysis identified the duration of disease before hospital admission (odds ratio (OR) = 1.24) and the extent of brain involvement on MRI at the time of admission (OR = 37.22) as two independent risk factors associated with poor prognosis. Conclusions: Although HSVE fatality regressed considerably with acyclovir treatment, many patients survive with sequelae. Our results emphasize the importance of early diagnosis and prompt treatment of HSVE.
A Probable Case of Herpes simplex Encephalitis despite Negative PCR Findings Findings
Infection, 2001
A 54-year-old woman was admitted to the hospital suffering from fever and personality changes. Laboratory examination of her cerebrospinal fluid (CSF) showed 270 mononuclear cells, 30 polynuclear cells and a clinically low number of erythrocytes/mm 3. Empirical clinical findings from this case suggested treatment with acyclovir. Magnetic resonance imaging (MRI) showed bilateral temporal hyperintense signals in T2-weighted images. PCR with specific primer for herpes simplex virus type 1 (HSV-1) and HSV-2 were negative. There was no elevation of oligoclonal antibodies specific to HSV in CSF after 2 weeks. Although we did not prove the presence of the agent microbiologically at the clinical onset of the disease, the MRI and electroencephalogram (EEG) findings, erythrocytes in CSF and the dramatic response to acyclovir therapy are suggestive of a diagnosis of herpes simplex encephalitis (HSE).
Double Trouble with Herpes Simplex Virus 1 Encephalitis
journal of medical science and clinical research, 2020
Herpes Simplex virus (HSV) is the most common cause of fatal sporadic necrotising viral encephalitis. The incidence is two cases per million people per year. They are associated with high mortality and morbidity without proper treatment. We report a case 46 years old with clinical features suggestive acute encephalitis. Despite various modalities of investigations for diagnosis of HSV are available, it posed a challenge. On the other hand two of the rare complication of HSV infection, myoclonic epilepsy and rhabdomyolysis occurred in this patient despite prompt initiation of the treatment.
A Case of Herpes Simplex Virus-1 Encephalitis from a Medicolegal Point of View
Case Reports in Medicine, 2018
We present a case of herpes simplex virus-1 encephalitis (HSVE) and discuss the difficulty of early diagnosis and the possibility of a wrong or delayed diagnosis and treatment of this encephalitis. We show the importance of considering HSVE to pursue every case of suspicious medical liability.